Thinking “inclusion first” and not “digital first” is central to combating health inequality

Covid-19 necessitated an unexpected and seismic shift in the way health and care services function. Face-to-face services closed overnight and digital platforms were rolled out urgently. While these worked well for many people, allowing them to avoid travel costs and time and potential infection risk from GP or hospital waiting rooms, many people were excluded from accessing care—locked out by the digital front door.

For National Voices, digital exclusion has been a major priority since last year, where we conducted a rapid listening exercise and produced practical top tips for remote and virtual care in our report: The Dr Will Zoom You Now. What came through clearest of all from hearing people’s experiences—both positive and negative—is that healthcare services must not make assumptions or homogenise communities: one size does not fit all. Now, we are launching a new voice-led project which began with listening to the experiences of those most at risk of exclusion, such as people with learning disabilities, complex health and communication needs, and people from low income and minority ethnic backgrounds. Digital exclusion sits at the intersection of many inequalities and those with more money, private spaces, higher literacy, and digital skills, as well as a deeper trust of the health system are more likely to be able to overcome barriers to accessing care remotely. 

Everyone has a right to access care in a way that works for them. For many people, online forms, apps, and video calls are simply not workable. When communication preferences and requirements are not adhered to, low quality care, or exclusion from care altogether, is the result. We have co-produced information for patients, endorsed by the Royal Colleges of GPs and Physicians to ensure that patients understand—and feel empowered to act on—their options. For system designers and deliverers, thinking “inclusion first” and not “digital first” is central to combatting health inequality and building a system which truly works for everyone. We are raising these points with system leaders and professional bodies to link up thinking around personalisation, inequality, and care transformation in more effective ways.

Times of crisis often spark innovation, bravery, and collaboration, and the past year has been no exception. Voluntary and community organisations, often in partnership with statutory services, have innovated fantastically to engage their beneficiaries in new ways. In our new report, we spotlight services and interventions which have embodied the principle of inclusion first. We have drawn out keys to inclusive innovation which include supporting staff throughout and crucially, co-designing from the beginning. Innovation is led by people first, then technology. No matter how urgently changes are needed, co-design is a necessity to ensure services meet people’s diverse requirements, preventing further exacerbation of inequalities. As we move into a more complex and digitised world, offering informed, supported choice is more important than ever. Any innovations must be tailored appropriately to the diverse needs of service users: quality care is personalised care.  

Finally, we know that health is wider than healthcare. Digital exclusion may be a fairly new dimension of inequality, but inequality is nothing new. People’s health outcomes are affected by a range of reasons such as ethnicity, geography, gender, career, migration status, disability, and much more. The complexity of people’s backgrounds cannot be ignored when developing new services and engagement interventions. But the boundary between informal and formal care, social capital and health and wellbeing innovations is blurred. The healthcare sector can capitalise on this, using trusted relationships and community-led approaches to see the transformations taking place as an opportunity to prioritise equality, inclusion and to engage more people than ever before.

Savannah Fishel, Policy and Engagement Officer, National Voices.

Competing interests: none declared.